Module One: Introduction to the Clinical Practice of Psychology

Transcription

1 Module One: Introduction to the Clinical Practice of Psychology PSY 455 Rick Grieve, Ph.D. Western Kentucky University Clinical Psychology Definition: The field of clinical psychology involves research, teaching, and services relevant to the applications of principles, methods, and procedures for understanding, predicting, and alleviating intellectual, emotional, biological, psychological, social, and behavioral maladjustment, disability and discomfort, applied to a wide range of client populations. Resnick, 1991, p. 7 Clinical Psychology What sets clinical psychologists off from other people who perform similar functions is a focus on science. Scientific clinical psychology is the only legitimate and acceptable form of clinical psychology Richard McFall, 1991, p. 76 1

2 Historical Perspectives Demonological Model Abnormal behavior caused by demonic possession Divine will and spirits Treatment for abnormal behavior logically follows from the perceived cause(s) Early Greek Ideas Origins of the Medical Model Hippocrates Historical Perspectives Four Humours Phlegm phlegmatic Black Bile Melancholia Blood sanguine Yellow Bile choleric Galen Medieval Times Belief in supernatural again Roman Catholic Church influence Exorcism Historical Perspectives Witchcraft More likely to be someone who was not liked as someone who exhibited abnormal behavior Paracelsus Asylums Became storehouse for mentally ill in 15 th & 16 th centuries Treatment horrid St. Mary s of Bethlehem 2

3 Historical Perspectives Franz Anton Mesmer Reform Movement and Moral Therapy Jean Baptiste Pussin Phillipe Pinel Moral therapy Philosophy that emphasized treating hospitalized patients with care and understanding William Tuke Dorothea Dix Benjamin Rush Historical Perspectives A Step Backward Apathy Calls for mental health care reform Community Mental Health Movement Came about due to the invention of phenothiazines Deinstitutionalization It does have its critics Historical Perspectives Contemporary Perspectives Biological Psychological Diathesis-Stress Sociocultural Biopsychosocial 3

4 Functioning as a Scientist-Practitioner Fig. 1.2, p. 6 MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse EDUCATION: M.D. plus three year residency in psychiatry ROLE: Prescribes medications; supervises hospital stays; psychotherapy 4

5 Typical Daily Activities: See patients in 15-minute increments Manage medication Oversee hospitalized patients Can conduct physical examinations of patients Treat physical ailments MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse EDUCATION: Master s or Ph.D., plus one year internship ROLE: Psychotherapy may follow one or more theoretical orientations (e.g. behavioral, psychodynamic) Typical Daily Activities See clients in one-hour time blocks for therapy Complete intellectual or personality assessments Including diagnosis Consult Supervision Teaching Research Administration 5

6 Where do clinical psychologists work? Setting Primary (%) Secondary (%) Independent Private Practice Individual Group Hospitals Other Human Service Settings Managed Care 5 3 Business & Government 7 9 Academia Distribution of Licensed Psychologists, Distribution of Licensed Psychologists, Per 100,000 Population

7 MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse EDUCATION: Master s or Ph.D., plus one year internship ROLE: Helps people make career choices or other changes in their lives; some psychotherapy Typical Daily Activities See clients in one-hour time blocks for therapy Consult Supervision Teaching Research Differences between clinical and counseling psychologists 2x as many people apply to clinical programs, though acceptance rates are similar GRE scores are higher for clinical Counseling programs accept more minority students and students w/master s degrees Research focusing on minority issues is more common in counseling programs Research focusing on psychological disorders and health psych is more common in clinical programs 7

8 MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse EDUCATION: Ph.D. or M.D., plus specialized training in psychoanalysis ROLE: Psychoanalytic psychotherapy Typical Daily Activities See clients almost daily for one-hour therapy sessions Also do brief psychotherapy If also physicians, can prescribe medications MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse EDUCATION: Ph.D. or Ed.S., plus one-year internship ROLE: Problem solver within the school system. 8

9 Typical Daily Activities Solve problems in schools Adjustment issues with children Programmatic issues Advocate for evidence-based practices in schools Complete intellectual and personality assessments Team meetings to develop IEPs Meet with students and families and teachers for interventions (sometimes therapy) What Is the Role of a School Psychologist? Assessment Consultation for student and systems-level change Prevention Intervention Staff, parent, and student education Research and program development Mental health care Advocacy MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral counselor Social Worker Psychiatric Nurse EDUCATION: Bachelor's in divinity, plus training in counseling ROLE: Supportive counseling to people in congregation going through difficult times 9

10 Typical Daily Activities Complete therapy and integrate religious teachings into the therapy sessions MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral Counselor Social Worker EDUCATION: Bachelor s or Master s degree in social work ROLE: Assist those with problems to deal with life-threatening issues. Typical Activities Crisis management Counseling/Intervention Group and individual Home visits Field is growing 10

11 MENTAL HEALTH PRACTITIONERS Psychiatrist Clinical psychologist Counseling psychologist Psychoanalyst School Psychologist Pastoral Counselor Social Worker Psychiatric Nurse EDUCATION: Associate s, Bachelor s or degree in nursing; Master s degree in psychiatric Nursing ROLE: Collaborate with other professionals to provide treatment, provide medical education, prescribe meds. Typical Activities Collaboration Medical Education Case Management Therapy Medication Management Mental Health Practitioners? Life Coach Option for people who want to help others but not be licensed. Although lack of regulation = problem Different goals in treatment, approach to treatment, and clients 11

12 Graduate School What does it take to get into graduate school? Recent (2005) survey: (1 = low, 2 = medium, 3 = high) Master s Programs: Letters of Recommendation: 2.74 Research Experience: 2.04 Work Experience: 1.91 Clinically-Related Public Service: 1.94 Extracurricular Activity: 1.46 Interview: 2.30 Personal Statement: 2.63 GRE Scores: 2.36 GPA: 2.75 Graduate School Recent (2005) survey: (1 = low, 2 = medium, 3 = high) Doctoral Programs: Letters of Recommendation: 2.82 Research Experience: 2.54 Work Experience: 1.87 Clinically-Related Public Service: 1.91 Extracurricular Activity: 1.41 Interview: 2.62 Personal Statement: 2.81 GRE Scores: 2.50 GPA: 2.74 Graduate Programs at WKU WKU offers graduate-level psychology programs in: Clinical Psychology (MA) School Psychology (EdS) Industrial/Organizational Psychology (MA) Experimental Psychology (MA) Counseling Social Work 12

13 Graduate Programs at WKU Admission Minimum Requirements: GPA: 2.75 Psy GPA: 3.00 GRE: 850 (Verbal + Quantitative) 12 hours of undergraduate psychology courses Three letters of recommendation Completion requirements Graduate Programs at WKU Averages for FA 2010 WKU Clinical Acceptees (and average for last eight years): Number: 9 (128) GPA: 3.39 (3.45) Psych GPA: 3.49 (3.59) GRE Verbal: 153 (154) GRE Quantitative: 150 (150) GRE Analytical Writing: 4.11 (4.25) GRE Total: 302 (304) Graduate Programs at WKU Averages for FA 2010 (Fa2007) WKU School Ed.S. Acceptees: Number: 7 (12) GPA: 3.65 (3.49) GRE Verbal: 486 (440) GRE Quantitative: 593 (546) GRE Analytical Writing:?? (4.6) GRE Total: 1079 (986) 13

14 Graduate Programs at WKU Averages for FA 2006 WKU Counseling MA Students: Number: 25 (currently enrolled in program) GPA: 3.39 GRE Verbal: 450 GRE Quantitative: 506 GRE Total: 956 Graduate Programs at WKU Changes to Counseling MA program: number of students: between 40 to 48 total Four concentrations: School counseling Clinical mental health counseling Marriage and family therapy, Student affairs The application process Completing an admissions portfolio interview with an admission committee 3 faculty members and 1 current student. Graduate Programs Averages for 2009 Clinical Ph.D. Programs (members of the Academy of Psychological Clinical Science): GPA: 3.7 GRE Total: 1330 Percentage of applicants accepted: 4.9% Number of offers extended: 10.6 Number enrolled:

15 Graduate Programs Averages for 2009 Clinical Ph.D. Programs (non-members of the Academy of Psychological Clinical Science): GPA: 3.6 GRE Total: 1241 Percentage of applicants accepted: 10.4% Number of offers extended: 12.6 Number enrolled: 7.8 Graduate Programs Averages for Master s Level Acceptees: GPA: 3.37 Psych GPA: 3.48 GRE Verbal: 504 GRE Quantitative: 549 GRE Total: 1055 What if you don t want to go to grad school? Do you have to go to graduate school to get a job with a psychology degree? 15

16 Top 10 Skills Employers Like in Psychology Majors Listening Skills Ability to Work on Teams Interpersonal Awareness Desire and Ability to Learn Willingness to Gain New Skills Focus on the Customer/Clients Environmental Awareness Top 10 Skills Employers Like in Psychology Majors Adaptability Critical Evaluation Problem-Solving Skills Other Skills Gained With a Psychology Major Literacy Statistical Familiarity Computer Literacy Research Skills Perspective Pragmatism 16

17 So, what kind of job can I get with my B.A. in Psychology? 50% of Psychology graduates were employed with a for-profit company 20% public affairs or social services 13% teaching 9% sales 9% state or local government Salary range 2001 survey Range of $21,900-$40,000 Management: $30488 Teaching: $25,378 Counseling: $24,724 Social Work: $23,988 Sales: $34,451 Government: $20,000-$29,000 Licensure What the heck is licensure, anyway? Purpose of licensing board: to determine standards for admission into the profession to screen applicants applying for licensure to regulate the practice of psychology for the public good to conduct disciplinary proceedings involving violations of standards of professional conduct as defined by law 17

18 Different Types of Licenses Licensed Psychologist Education: Doctorate in Psychology (Ph.D., Psy.D., Ed.D.) Training: One year postdoctoral training, pass EPPP, pass Oral Exam Supervision: One hour per week for one year, then none Supervisor: Licensed Psychologist Different Types of Licenses Licensed Psychological Practitioner Education: Master s in Psychology (M.A., M.S.) Training: 60 hours of graduate training, pass EPPP, pass Oral Exam Supervision: One hour per week for five years (after two years, can petition for less frequent), then none Supervisor: Licensed Psychologist Different Types of Licenses Psychological Associate Education: Master s in Psychology (M.A., M.S.) Training: 48 hours of graduate work, pass EPPP Supervision: One hour per week for one year (after two years, can petition for less frequent) Supervisor: Licensed Psychologist 18

19 Different Types of Licenses Licensed Clinical Social Worker Education: Master s in Social Work (MSW, MSSW) Training: 60 hours of graduate work, pass licensing exam Supervision: One hour per week for two years, afterwards none Supervisor: Licensed Clinical Social Worker Different Types of Licenses Nationally Certified School Psychologist Not really a license a certification Education: Ed.S. in School Psychology Training: 60 hours of graduate work, 1200 hour internship. pass licensing exam Supervision: N/A Allows School Psychologists to easily move to a new state (that accepts the credential) Different Types of Licenses Licensed Marriage and Family Therapist (LMFT) Education: Master s in Family Studies (or other discipline that meets Board requirements) Training: 60 hours of graduate work, pass a licensing exam Supervision: 200 hours of supervision to be completed in fewer than two years; no supervision once fully licensed Supervisor: LMFT or other Board-approved individual 19

20 Different Types of Licenses Licensed Professional Counselor (LPC) Education: Master s in Counseling (M.A.) Training: 60 hours of graduate work with specific courses, pass a licensing exam Supervision: 4,000 hours past Master s Supervisor: Board-approved supervisor History of Clinical Psychology Significance is not in names and dates, but, rather, in understanding factors that have shaped clinical psych Most come from outside the field itself Slow and gradual Clinical psychology has emerged as a profession only recently and is still working to define its identity History of Clinical Psychology Early Approaches to Mental Health care Others who have done it Clergy Shamans Physicians Individuals committed to societal welfare 20

21 History of Clinical Psychology Demonological Model Divine will and spirits Abnormal behavior caused by demonic possession It is the result of punishment by God Treatment for abnormal behavior logically follows from the perceived cause(s) History of Clinical Psychology Somatogenic explanation Hippocrates Four Humours Phlegm phlegmatic Black Bile Melancholia Blood sanguine Yellow Bile choleric History of Clinical Psychology Moral Therapy Patients need to be treated humanely Phillipe Pinel Benjamin Rush Psychological Explanations of Abnormal Behavior Jean Charcot, Hippolyte Bernheim, & Piere Janet Hypnosis Which, of course, leads us to Freud 21

22 History of Clinical Psychology Biopsychosocial Model Biological factors Genetics that contribute vulnerability Dysregulation of neurotransmitters Psychological factors Attention Self-perception Causal attributions Emotions History of Clinical Psychology Social Factors Stressful life events Chronic stress Interpersonal relationships Social contexts History of Clinical Psychology It is important to note that the science of psychology preceded the profession of psychology Reverse of what usually happens Wundt begins the science of psychology Though there are arguments for other people 22

23 The History of Clinical Psychology Lightner Witmer ( ) student of Wundt promoted the practical application of psychology Coined the term clinical psychology Began the first psychology clinic in 1896 Offered 1 st course in clinical psychology Began 1 st clinical journal: Psychological Clinic Clinics for Child Evaluation Received referrals for a number of different problems The History of Clinical Psychology Had no examples or precedents So, he created his own standardized assessments and treatments Used a treatment team approach But a psychologist was the most prestigious member Had physicians examine kids Originally believed genetics to be the cause of the behaviors Later espoused environmental causes Presented ideas to APA in 1896 to a cool reception The History of Clinical Psychology Books that provided an impetus to the field: A Mind that Found Itself (1908) Clifford Beers Psychotherapy (1909) Hugo Munsterberg 1 st child guidance clinic established in 1909 by William Healey in Chicago WWI Freud advanced the field of clinical psychology Impact on psychology 23

24 The History of Clinical Psychology Clinical Psychology within APA Clinical Psych in the 1930s & 40s Clinical psychology remained a small part of psychology until WWII Testing movement advances clinical psychology Impact of VAs on clinical psychology The Boulder Model Scientist-practitioner The Vail Conference In 1968 design for Psy.D. Today 60,000 clinical psychologists The History of Clinical Psychology Research that changed the field Hans Eysenck (1952) Psychotherapy research Paul Meehl (1954) Clinical Judgment Sucks Carl Rogers (1954) Person-centered therapy Joseph Wolpe (1958) Systematic Desensitization The History of Clinical Psychology Albert Bandura (1969) Modeling & vicarious learning Smith & Glass (1979) Meta-analysis Also showed that psychotherapy was effective Finally refuted Eysenck Elkin et al. (1985) Psychotherapy treatment is effective Dodo bird effect 24

25 References DeAngelis, T. (2010). First class coaching: Demand for life coaches is growing, but the area remains poorly regulated and researched therein creating an opportunity for psychologists. APA Monitor on Psychology, 41 (10), Kendler, H. H. (1987). Historical foundations of modern psychology. Pacific Grove, CA: Brooks/Cole. Michalski, D. S., & Kohout, J. L. (2011). The state of the psychology health service provider workforce. American Psychologist, 66, Munsey, C. (2009). Graduates debt goes up threefold in 12 years. APA Monitor on Psychology, 40 (9), 17. Norcorss, J. C., & Cannon, J. T. (2008). You re writing your own letter of recommendation. Eye on Psi Chi, 13 (1), Norcross, J. C., Kohout, J. L., & Wicherski, M. (2005). Graduate study in psychology: 1971 to American Psychologist, 60, References Schultz, D. P., & Schultz, S. E. (1996). A history of modern psychology (6 th edition). Ft. Worth, TX: Harcourt Brace Publishers. Schultz, D. P., & Schultz, S. E. (2004). A history of modern psychology (8 th edition). Ft. Worth, TX: Harcourt Brace Publishers. 25